Team Lead, Auditing

Accountabilities:: Lead, mentor, and support a team of auditors, managing workloads, priorities, performance, and professional development. Coordinate with cross-functional teams to align on production goals, quality reviews, workflows, and required timelines. Conduct comprehensive coding and DRG reviews to validate accuracy, reimbursement, diagnosis assignments, and potential overpayments. Apply advanced knowledge of coding guidelines and industry tools to identify payment integrity opportunities and improve audit efficiency. Prepare clear, concise, and well-supported audit findings using authoritative references such as AHA Coding Clinic guidance and ICD-10-CM/PCS regulations. Use advanced DRG encoder tools to support accurate and efficient auditing. Meet or exceed established quality and productivity standards, including strong uphold rates for appeals. Maintain current knowledge of coding updates, compliance requirements, reimbursement trends, and healthcare payment policies. Ensure adherence to HIPAA requirements and applicable policies and procedures for data security and regulatory compliance. Support inpatient audits involving case-rate and per-diem reimbursement, with additional exposure to outpatient and professional claims auditing as applicable. Requirements 8+ years of experience performing MS-DRG and ARP-DRG reviews for a Payment Integrity vendor or payer. 2–3 years of supervisory or management experience, including experience supervising and training teams in a remote work environment. CCS certification is highly preferred. RHIA or RHIT certification preferred, along with an Associate’s Degree in Health Information Management, Nursing, or a related field. Preference for candidates who hold both a coding credential and an HIM credential such as RHIA or RHIT. Advanced expertise in ICD-10-CM/PCS coding, with the ability to exercise sound professional judgment when evaluating complex clinical information, validating diagnosis assignments, and identifying coding discrepancies or upcoding. Strong knowledge of CMS NCDs/LCDs and clinical criteria guidelines. Demonstrated ability to develop well-supported audit findings using authoritative coding and regulatory references. Ability to work independently and remain highly productive in a fully remote environment while managing priorities and workflow autonomously. Strong analytical, written, and verbal communication skills, with exceptional attention to detail. Passion for DRG auditing, teamwork, collaboration, and continuous professional development. Experience in outpatient and professional claims auditing is preferred. Experience working in a startup or high-growth environment, demonstrating agility and adaptability. Comfortable collaborating with diverse, globally distributed teams. Strong computer skills and familiarity with Mac systems. Ability to travel approximately 5%, including potential travel to Boston, MA for onsite onboarding and occasional in-person team meetings. Must be legally authorized to work in the United States; immigration sponsorship is not indicated for this position. Benefits Annual salary range of $100,000–$110,000 , with total compensation also including bonus and benefits. Fully remote work opportunity. Approximately 5% travel. Medical, dental, and vision insurance. Life and disability insurance. Employee Assistance Program. 401(k) retirement plan with company match. Flexible Spending Account (FSA) and Health Savings Account (HSA) options. Flexible Time Off and company holidays. Up to 14 weeks of paid parental leave. Pet insurance. Opportunity to lead and develop an auditing team while contributing to payment integrity and reimbursement accuracy initiatives. Collaborative, growth-oriented environment with exposure to healthcare technology, analytics, and evolving payment integrity practices.